Euthanasia: the intensive care unit

The purpose of intensive care is to provide monitoring and organ support for patients with critical illness from which recovery is possible. Despite increasing technological and pharmacological sophistication, mortality in intensive care units remains high, with significant disability in those who survive. Methods of predicting outcome from intensive care have been developed. These enable patients to be placed in risk groups, but do not accurately predict the outcome of individual patients. That prediction is a clinical judgement based on the underlying disease, the number of body systems failing and the length of time for which intensive care support has been necessary. Once a decision has been made to withhold or withdraw intensive care, the principles of good palliative medicine should be employed during what will then be the inevitable terminal phase of the illness.